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Just another Herald-Tribune Media Group siteTue, 03 Mar 2015 17:30:41 +0000en-UShourly1http://wordpress.org/?v=4.1.1More worries rising from the ashes of cigaretteshttp://health.heraldtribune.com/2015/03/03/worries-rising-ashes-cigarettes/
http://health.heraldtribune.com/2015/03/03/worries-rising-ashes-cigarettes/#commentsTue, 03 Mar 2015 15:45:17 +0000http://health.wp.htcreative.com/?p=24295Read more »]]>A major new study of smoking and death has banged more nails into the coffin of cigarette smoking, though chances are it will do little to persuade any of the 42 million American smokers to quit.

A major new study of smoking and death has banged more nails into the coffin of cigarette smoking. (Benoit Tardif/The New York Times) -

If current smokers have not already responded to the well-established links between smoking and 21 diseases that together cause 480,000 deaths each year, adding another five diseases and 60,000 deaths to this grisly total is unlikely to make a difference — at least not by itself.

“Health effects are not enough to decrease smoking rates,” said Brian D. Carter, public health specialist with the American Cancer Society and lead author of the new study.

However, he and his co-authors hope that publication of their study in the The New England Journal of Medicine will prompt more doctors to aggressively address smoking cessation with their patients.

Perhaps even more important, our elected officials need to add muscle and money to quit-smoking programs and do more to thwart the persistent efforts of the tobacco industry to hook new young smokers and to keep older ones at it.

Nine in 10 smokers start before age 19. Every day, nearly 3,900 adolescents try their first cigarette, a quarter of whom are destined to become daily smokers. Nearly 1 in 3 will ultimately die of a smoking-related disease. That means some 5.6 million youngsters now under 18 will die prematurely because they smoked.

Many experts worry that the aggressive marketing of e-cigarettes, the latest gimmick to create and maintain an addiction to nicotine, could ultimately assure a healthy market for real cigarettes decades hence. No data exist to establish the longterm safety of this nicotine delivery system, nor is there convincing evidence that e-cigarettes are helping current smokers abandon tobacco.

Adolescents could be easily enticed by many of the flavors of e-cigarettes, including chocolate, vanilla, banana, cherry and strawberry, which sounds a lot like the menu in my local frozen yogurt store.

Certainly, tremendous progress has been made in curbing cigarette smoking since the first Surgeon General’s Report on Smoking and Health in January 1964. At the time, 44 percent of adults smoked, and just about anywhere they pleased. We’re now down to 18 percent of adults who smoke, and smoking is banned in many public buildings, workplaces, modes of transportation, and bars and restaurants.

But there has been a decided slowdown in smoking cessation rates in recent years, fueling a belief that getting the remaining hard core of smokers to quit will require new strategies.

For example, raising taxes on cigarettes is repeatedly proposed as an effective way to curb smoking, primarily by keeping young people from starting. Yet smoking rates are highest among the poor. While 17 percent of Americans at or above the poverty level smoke, the rate is nearly 28 percent among those living below the level.

People with few pleasures in life often cite smoking as one for which they are willing to make sacrifices. Since 1997, the smoking rate for adults has fallen 27 percent, but among the poor it has declined just 15 percent.

The Affordable Care Act requires insurance providers to cover tobacco cessation services with no copay from patients. Fully covered are two cessation attempts a year, each involving four counseling sessions and access to all tobacco-cessation drugs, over-the-counter and prescription, approved by the Food and Drug Administration.

However, political resistance in some states to expanding Medicaid under the act to many more low-income residents will effectively prevent those most in need of smoking cessation programs and tools from getting them.

Furthermore, death is by no means the only consequence of smoking. Countless millions of Americans are living with chronic smoking-induced illnesses that can impair their productivity and greatly increase health care costs.

A study of this nature, which followed nearly 1 million men and women from 2000 through 2011, cannot prove that smoking causes these disorders, but the fact that the risk for each illness declined as the number of years since quitting smoking increased strongly suggests a causeand- effect relationship. “The additional 60,000 deaths a year associated with smoking is more than what results from car accidents, influenza and murders,” Carter said in an interview. He added that the new findings “are not terribly surprising” given that tobacco smoke contains thousands of chemicals, many of which can impair immune function. Still, he said, “the morbidity associated with smoking is much greater than the mortality.” While dying of a smoking- induced disease is a singular event, being chronically ill with one can have costly, debilitating effects for decades.

Chronic kidney disease alone costs Medicare $57.5 billion a year.

“Smoking is the single worst thing people can do to their health,” Carter said. “People underestimate how efficiently addictive cigarettes are.”

He cited the case of his grandparents, who smoked for decades and failed repeated attempts to quit. Both were sick for years with congestive heart failure and emphysema before dying of the flu at 72.

“Smoking should be treated as a form of drug addiction,” Carter said. “It functions the same way as addiction to alcohol or heroin.”

For decades, the tobacco industry has managed to thwart public health efforts to depict smoking as the noxious, lethal activity that it is. It introduced flavors and filters, appealed to women’s status concerns and weight issues, and seduced youngsters by infiltrating movies popular with teens.

The FDA now has the authority to regulate tobacco more strenuously, and should be using it to counter the industry’s efforts to make its product more palatable and seemingly less dangerous.

]]>http://health.heraldtribune.com/2015/03/03/worries-rising-ashes-cigarettes/feed/0So-called ‘superfoods’ are not magic bullets against cancerhttp://health.heraldtribune.com/2015/03/03/24276/
http://health.heraldtribune.com/2015/03/03/24276/#commentsTue, 03 Mar 2015 13:30:49 +0000http://health.wp.htcreative.com/?p=24276Read more »]]>Blueberries. Green tea. Tomatoes. And, oh, that cruciferous cauliflower. All make the lists of superfoods that might help prevent cancer. Then there are the foods such as smoked meat and fried foods that supposedly might cause cancer.

Such information is standard fare for TV doctors and Web sites, but most of us don’t know how to judge such claims.

What sounds authoritative may not be. Only about half of the recommendations on two internationally syndicated TV medical talk shows were supported by scientific evidence, according to a recent study in the journal BMJ.

“The messages that the public is getting are bits and pieces, without the big picture,” said Walter Willett, chair of the Department of Nutrition at the Harvard School of Public Health. “It’s sort of the Wild West out there in terms of what people hear about nutrition and cancer.”

Of course, the blueberries we eat today are good for us. But nutrition’s role in cancer prevention is much more complex than a single dietary component: Evidence has mounted, for example, that lifestyle — diet, weight control and exercise — is vital in helping reduce risk.

For now, experts endorse general dietary advice that is healthful for a variety of chronic diseases and conditions, rather than reductionist thinking that focuses on single foods or nutrients.

Reductionist thinking neglects the broader approaches of cancer nutrition research, including eating patterns and the mechanisms of microbiology. The quest now is for answers about nutrition’s relationship to the many challenges of cancers — challenges that go beyond any individual study.

BE SKEPTICAL

When you hear that a certain food helps prevent cancer, ask: Which cancer?

“Cancer is multiple diseases,” said Marian Neuhouser, a nutritional epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle.

Whereas cardiovascular disease might be broken down into several types, including myocardial infarction, stroke and peripheral vascular disease, she said, “for cancer, it’s really over 100 different diseases.”

“Cancer is a very complex, very challenging disease to study, whether you’re looking at it on the cell level or the clinical level or the epidemiologic and preventive level,” Willett said.

Cancer occurs when abnormal cells divide uncontrollably. But one cannot assume that all cancers operate in the same way, said Geoffrey Kabat, a cancer epidemiologist at the Albert Einstein College of Medicine in New York. Different cancers can have somewhat different risk factors, which may or may not overlap: The cancers linked to tobacco, for example, might differ from those linked to radiation.

Researchers caution about overreacting to a single study. New findings come out every week, but “we never take any one study to be the answer to anything,” said Nancy Potischman, a nutritional epidemiologist at the National Cancer Institute. Only if the same results come up in multiple studies across multiple populations, “then you might think that, yes, this food might be important,” she said.

While it’s relatively easy to see the effect of a food on a lab animal, it’s difficult to study humans, who put variety on their plates.

Population studies query participants about what they eat and follow them through a time period. Clinical trials might have a group that eats a certain food or nutrient and a control group that doesn’t consume that food, but these studies are very expensive, specific and hard to organize and maintain.

Sometimes findings that are promising in early research don’t prove to be definitive in follow-up studies.

Still, we yen for simple strategies. For a while, attention focused on folic acid, which didn’t quite live up to all its hopes, at least for cancer. Now there’s a great deal of interest in vitamin D.

“There’s a process of making hypotheses and testing them,” said Jo L. Freudenheim, a professor of epidemiology and environmental health at the State University of New York at Buffalo. “To the extent this goes out to the public, it can lead to unreasonable expectations.”

And that can set off the next new fad.

HEALTHY HABITS

Tobacco use remains the leading preventable cause of cancer incidence and death worldwide. After tobacco, the lifestyle trio of diet, weight control and exercise may be linked to one-third to two-thirds of cancers.

“They’re inseparable,” Neuhouser said. “You can have a great diet and you can have a healthy weight, but if you’re extremely sedentary then there’s a risk.”

And there’s a strong link between excess weight and several kinds of cancer, including the esophagus, breast (after menopause), endometrium, colon and rectum, kidney, pancreas, thyroid, gallbladder, according to the NCI. Exercise helps balance calories consumed and calories burned.

Evidence mounts about how lifestyle may affect risk of cancer. In the largest study of its kind, nearly half a million Americans were evaluated for adherence to American Cancer Society cancer prevention guidelines that include smoking avoidance; a healthful, consistent weight; physical activity; limiting alcohol; and a diet emphasizing plants.

Those who followed the guidelines most closely had lowered risk of developing cancer (10 percent for men, 19 percent for women) and dying from cancer (25 percent for men, 24 percent for women) compared with those whose habits were least in line with the guidelines.

Most striking was the reduction of overall risk of dying: 26 percent for men, 33 percent for women during the 14-year study period.

Fourteen types of cancer seemed affected by lifestyle behavior, most particularly gallbladder, endometrial, liver and colorectal. For men and women, a healthful weight and physical activity were the top factors in reduced deaths overall. Albert Einstein College of Medicine Researchers published this analysis online in January in the American Journal of Clinical Nutrition, based on data from a National Institutes of Health/AARP study.

Kabat, the study’s lead author, said that these results, while encouraging, might be explained by unknown factors: Those who best follow guidelines might be particularly health-conscious and have good access to health care. But overall, the findings affirm decades of other studies showing that “maintaining a healthy weight, physical activity and maybe certain aspects of diet are associated with better health,” he said.

Another approach to cancer and nutrition considers dietary patterns. “What we eat on any one day is not going to change our cancer risk, but it’s the pattern over the long term.” Neuhouser said. Several diets that emphasized fruit, vegetables, whole grains and plants or plant-based proteins were analyzed against information collected over more than 12 years from nearly 64,000 post-menopausal women in the Women’s Health Initiative Observational Study. Consuming a high-quality diet was associated with lower death rates from chronic diseases including cancer, as reported last year in the American Journal of Epidemiology.

WHAT WE EAT, WHEN

For researchers in the field of developmental nutrition, the quest is not what you eat, but when you eat it.

“We don’t fully understand whether or not there are certain periods of life which are more important to have healthy aspects of the three pillars” of diet, exercise and weight, Neuhouser said.

For breast cancer, for example, researchers are looking at nutrition at birth and time of first period through first pregnancy, Freudenheim said. Evidence is increasing that eating red meat in high school might have a bearing on the development of some kinds of breast cancer decades later, Willett said.

Also, alcohol consumption by young women may raise the risk of breast cancer later in life. Greater understanding of metabolism might offer clues to how cancer cells develop, according to the National Cancer Institute’s Potischman. Metabolomics is an emerging branch of science that focuses on metabolites, the substances produced through digestion and other bodily processes.

The bacteria, viruses and other organisms that live in and on humans seem to play a bigger role in health and disease than was previously understood, Freudenheim said. How the countless microbes in such areas as the gut and the mouth might contribute to or prevent cancers is one of the open questions in the new area of study of the microbiome, which refers to the many organisms in the body, 10 percent of which are human and 90 percent nonhuman.

Nutrigenetics considers what we eat, the components in our foods and their interactions with genetic processes.

Regarding diet, “right now we’re making blanket recommendations, but one size doesn’t fit all,” says Stephen Hursting, a professor of nutrition at the University of North Carolina at Chapel Hill. He said that someday research on our genetic and biochemical differences might lead to personalized dietary recommendations to reduce cancer risk.

]]>http://health.heraldtribune.com/2015/03/03/24276/feed/0For some terminal patients, routine procedures can be unnecessaryhttp://health.heraldtribune.com/2015/02/20/terminal-patients-routine-procedures-can-unnecessary/
http://health.heraldtribune.com/2015/02/20/terminal-patients-routine-procedures-can-unnecessary/#commentsFri, 20 Feb 2015 10:00:42 +0000http://health.wp.htcreative.com/?p=23940Read more »]]>DEAR DR. ROACH:My mother has stage 4 cancer. She just went to a dermatologist, who performed Mohs surgery on her nose. I am BEYOND upset by this unethical behavior. The country is already deeply in debt, and Medicare is paying for this? Unconscionable! Not to mention the pain and suffering of my mother, who is now at risk of a secondary infection. I was sickened by the entire ordeal. -- J.B.

ANSWER: I agree with you completely that often patients with terminal diseases receive unnecessary care. There have been studies clearly documenting this. However, the studies don't answer why, in a particular case, a physician performed these treatments, which add only pain, anxiety and expense.

I suppose it is possible that the motivation is simple greed; however, I still have enough faith in my colleagues that I think that is a very unusual reason; I think it's far more likely that a specialist just doesn't see the big picture. There's an old expression that when all you have is a hammer, the whole world looks like a nail, and I think some specialists see a problem and fix it without realizing that the problem they are fixing isn't likely to ever cause symptoms.

For example, primary-care doctors order unnecessary tests, especially screening tests. I see mammograms ordered for women with advanced colon or ovarian cancer who are in palliative care, and this makes no sense. I have heard some physicians mention that insurance companies monitor the frequency of "quality indicators," such as mammograms, which affect their ratings and reimbursement. That's an example of a well-meaning system motivating wrong behavior.

I should emphasize that not all care for terminal patients is useless. If the goal is to improve quality of life or reduce suffering, then I am all for it, after a consideration of the costs (pain and inconvenience as well as dollar costs).

DEAR DR. ROACH:Could you please discuss the use of Prevagen for Alzheimer's disease? My chiropractor wants me to take it because my mother had Alzheimer's. She says her father is doing well and not progressing. What do jellyfish have to cause this result? I have not heard any research from medical facilities that back this up. -- L.C.

ANSWER: I could not find any peer-reviewed literature that supports the use of Prevagen for Alzheimer's disease or other neurological disease. The company that makes the product has unpublished data on its website that suggests there may be a benefit in memory. There is also a study in rats that suggests the active protein, apoaequorin, may protect nerve cells against loss of glucose and oxygen. This protein was originally identified from luminescent jellyfish but is made synthetically in Prevagen. The rat research result is surprising, since proteins are normally broken down in the GI tract, and normally would not be expected to have activity in the brain.

There are reports made to the Food and Drug Administration of serious adverse events from this product. A supplement is not required to show its benefit; in fact, the product information for Prevagen clearly states that it is "not intended to diagnose, treat, cure, or prevent any disease." Although I understand why people would be interested in trying to prevent or treat Alzheimer's disease, I don't recommend using this product until there is clear, peer-reviewed evidence that it is better than placebo. In my mind, taking any treatment -- drug or supplement -- to prevent a condition requires the highest level of certainty.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/02/20/terminal-patients-routine-procedures-can-unnecessary/feed/0Colon cancer screening guidelines have changedhttp://health.heraldtribune.com/2015/02/19/colon-cancer-screening-guidelines-changed/
http://health.heraldtribune.com/2015/02/19/colon-cancer-screening-guidelines-changed/#commentsThu, 19 Feb 2015 10:00:06 +0000http://health.wp.htcreative.com/?p=23938Read more »]]>DEAR DR. ROACH:I am a 74-year-old female, and I just had a colonoscopy. This is my fourth one in 17 years, and I have never had any kind of problems or polyps. My doctor told me that I do not need any more colonoscopies in the future. There was cancer in my family (my father died of colon cancer at age 74), but he never had a checkup or a screening until it had spread.

I am a little confused, because another doctor told me that I should have a screening every five years, no matter what my age, because of my family history. -- E.K.

ANSWER: The most recent guidelines from the American College of Gastroenterology have changed. They now state that if a person has only a single family member diagnosed with colon cancer over the age of 60, they can be screened like an average-risk person. The ACG does not recommend a time to stop colon cancer screening, but the U.S. Preventive Services Task Force recommends stopping at age 75.

It's very important to remember that these are guidelines. It may be appropriate in certain individuals to do more or less screening according to other risks they may have.

DEAR DR. ROACH: I have a question concerning estradiol. My gynecologist has me taking 1 milligram of estradiol daily. My internist recommends that I not take it. Which recommendation should I follow? I have never had hot flashes, so that is not a problem. My internist says that I need to gradually stop taking the estradiol. He says that this medicine has more problems than benefits.

It is hard to choose what to do. What do you recommend? -- H.L.

ANSWER: Back in the 1990s, we often recommended that women take estrogen in order to prevent problems, in addition to treating hot flashes. Two important studies came out showing that estrogen appeared to cause problems as well as prevent them. The definitive answer as to whether estrogen causes more problems than it prevents still isn't known, and it probably depends on many factors. The term "estrogen" as I am using it refers to a group of related compounds. Estradiol is sometimes referred to as "bioidentical," since it is the same hormone that a woman's body makes, as opposed to conjugated equine estrogen (Premarin), which was most commonly used in the 1990s and earlier. The type of estrogen may make a difference in terms of risk. Also, estrogen is seldom given without a progesterone compound in women who have not had their uterus removed, and the type of progesterone appears to make a major difference in risk.

Briefly, the evidence suggests that estrogen reduces the risk of colon cancer and of osteoporosis and fractures. However, it increases the risk of blood clots. The largest areas of confusion are in breast cancer and heart disease. For conjugated estrogens with medroxyprogesterone, which has the best information, for 1,000 women in 10 years there were seven more heart attacks, eight more strokes, eight more blood clots in the lungs and eight more invasive breast cancers, but six fewer colon cancers and five fewer hip fractures.

Recent data suggest that women who start estrogen immediately at menopause have a lower risk of heart disease than those who start five or 10 years after menopause (in fact, they may have an overall lower risk, compared with women who don't take estrogen). Women who took estrogen alone did not have an increased risk of breast cancer.

Because of the known harms of estrogen, at this time neither I nor any expert body recommends taking estrogen just to prevent problems. Until new studies become available, since you have no hot flashes, I agree with your internist.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/02/19/colon-cancer-screening-guidelines-changed/feed/0Lynch syndrome suggested in colon cancer casehttp://health.heraldtribune.com/2015/02/17/lynch-syndrome-suggested-colon-cancer-case/
http://health.heraldtribune.com/2015/02/17/lynch-syndrome-suggested-colon-cancer-case/#commentsTue, 17 Feb 2015 10:00:23 +0000http://health.wp.htcreative.com/?p=23931Read more »]]>DEAR DR. ROACH:A recent column regarding the man with advanced colon cancer after a normal colonoscopy had been done two years prior sent up a red flag for me. You did a column in March of this year about Lynch syndrome, which occurs in 1 of every 5 patients with colon cancer. Sadly, it's often diagnosed after the cancer is discovered. Due to its aggressive nature, it may be the reason for the rapid advancement of this person's case.

Would you write an addendum regarding the possibility? It may help in H.B.'s case, and also will bring awareness to Lynch syndrome. Hopefully, genetic testing will be offered to her husband as well as any children they may have. -- O.C.

ANSWER: You bring up a good point. It is worth a reminder that the cancer should be tested for Lynch syndrome (also called hereditary nonpolyposis colorectal cancer, even though it may cause other cancers besides colon) so that the family can get proper advice about further screening. Some centers test all colon cancers for Lynch syndrome, but it's not routine. Especially if there is a family history of endometrial (uterus) cancer or colon cancer, Lynch syndrome should be suspected, and this testing should be done.

DEAR DR. ROACH:In 1976, I had a mole on my right calf about the size of a pencil eraser. A biopsy showed it to be melanoma, and they thought they had removed all of the cancer, but they did another surgery to be sure that I was cancer-free. I am a natural redhead and never sunbathed or used a tanning bed. It has been 38 years, and I am still cancer-free. I get a skin check from my dermatologist every six months.

At the time of my diagnosis, my family doctor said that if the melanoma spreads inside the body, "the ball game is over." Is that still true? I know melanoma can be deadly. -- W.K.

ANSWER: Melanoma is the most commonly lethal skin cancer. Although there have been some exciting new developments in treating advanced melanoma, the survival rate for stage IV melanoma, where the cancer has spread to internal organs, is only 15 percent to 20 percent at five years.

Fortunately, the survival rate for melanoma caught early, at stage I, is greater than 90 percent, which is why it's so important to know the ABCDE's of melanoma recognition:

A: Asymmetry -- one half looks different from the other half;

B: Border -- the border in a melanoma is often irregular, not a near-circle;

C: Color -- melanomas usually are not a uniform color, like most benign lesions. Some areas are light brown, others brown-black, others red or pale;

D: Diameter -- greater than 6 millimeters, the eraser on a standard pencil;

Any of these should prompt a visit to your regular doctor or a dermatologist. As an internist, these are the features I look for, and I have a very low threshold for sending suspicious lesions to my colleagues in dermatology.

READERS: Recurring vaginal infections are often troubling to women. The booklet on that topic explains them and their treatment. Readers can order a copy by writing: Dr. Roach -- No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6. Can. with the recipient's printed name and address. Please allow four weeks for delivery.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/02/17/lynch-syndrome-suggested-colon-cancer-case/feed/0Carcinoid tumors may be on the risehttp://health.heraldtribune.com/2015/02/16/carcinoid-tumors-may-rise/
http://health.heraldtribune.com/2015/02/16/carcinoid-tumors-may-rise/#commentsMon, 16 Feb 2015 10:00:01 +0000http://health.wp.htcreative.com/?p=23929Read more »]]>DEAR DR. ROACH:My father suffers from carcinoid syndrome, and I was wondering if it is hereditary. For many years now, I have gotten a strange numb feeling in my mid-abdomen region that comes and goes. At other times I have a mild, dull pain in the same area. I also have been experiencing a lot of gastrointestinal issues for the past several years. I have had many different tests done, which, for the most part, have been inconclusive. They did find that I have a hemangioma in one of the lobes of my liver. I quite often feel bloated and have bouts of diarrhea, and my stomach is very loud and noisy. -- E.H.

ANSWER: Carcinoid syndrome refers to the symptoms caused by the many active substances released by a carcinoid tumor, which usually include flushing -- a noticeable reddening of the skin -- and diarrhea, but also can include other symptoms. Carcinoid tumors are relatively rare, but their incidence seems to be increasing. They most commonly occur in the small bowel, but can be found in other body locations, including the lung.

There is a condition called familial cancer syndrome (the National Institutes of Health is currently recruiting study participants), but this represents only a small percentage of carcinoid tumors. They can occur as part of an endocrine disorder called MEN-1.

Because the symptoms of carcinoid can be so variable, and with your family history, I would recommend that you consult with a physician who is experienced in carcinoid syndrome. Abdominal pain and numbness are vague symptoms that are not common to carcinoid. They may make alternate diagnoses more likely, such as Zollinger-Ellison syndrome, a gastrin-secreting tumor that causes ulcers and diarrhea.

DEAR DR. ROACH: I've been diagnosed with a rare autoimmune disorder, scleroderma morphea. It's the inside-outside type, and I take 7 milligrams of methotrexate per week and 150 milligrams of prednisone per month. The pain often is intense in my hands and lower legs. My family practitioner and rheumatologist both have told me now, after several months, that this is all new to them and perhaps I should attempt physical therapy and look into some trials that could be going on somewhere. It's very confusing to me. I'm 78 years old and have had no joint surgeries, cancer or heart problems. I'd like to stay that way. -- S.D.

ANSWER: "Morphea" is another name for "localized scleroderma," which, unlike systemic sclerosis (scleroderma), does not affect the internal organs. So I'm not sure what you mean by "inside-outside" type. The treatment you are receiving is more common for systemic sclerosis than it is for morphea, which usually is treated with topically, with medicines applied to the body surface -- steroid creams, vitamin D and a powerful immune suppressant, tacrolimus. Phototherapy is another treatment option; it uses UV light.

Most cases of morphea are mild and resolve within three to five years. However, some people have a more severe and progressive disease. If treatment is not effective and the skin disease is severe, methotrexate and prednisone often are used. Physical therapy is, as is so often the case, extremely helpful in improving function.

Since your family practitioner and rheumatologist are out of their depth (I don't mean to disparage them; in fact, I give them respect for being honest -- nobody knows everything), I would find someone with expertise in this area, most likely a dermatologist and a rheumatologist at a teaching hospital.

READERS: The booklet on hepatitis explains the three different kinds. Readers can obtain a copy by writing: Dr. Roach -- No. 503, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/02/16/carcinoid-tumors-may-rise/feed/0Check in with doctor on checkup schedulehttp://health.heraldtribune.com/2015/02/12/check-doctor-checkup-schedule/
http://health.heraldtribune.com/2015/02/12/check-doctor-checkup-schedule/#commentsThu, 12 Feb 2015 10:00:59 +0000http://health.wp.htcreative.com/?p=23852Read more »]]>DEAR DR. ROACH: I normally go to the dermatologist once a year to get a skin check and follow up on some moles I had removed. Now the office recommends that I go every three months. What gives? -- F.M.

ANSWER: I'm guessing your dermatologist is keeping a close eye on something he or she doesn't like but isn't quite worried enough to do a biopsy. I don't want to second-guess your dermatologist. When you next go back, ask and find out. If you really dislike going so often -- perhaps because of co-payments, inconvenience or having to take time away from work or family -- tell him or her so that you both can work toward a plan that is easiest for you but still allows the dermatologist to keep you free from skin cancer or other problems.

DEAR DR. ROACH: I am 73 years old. Approximately two years ago, I noticed that my body hair (which was about 70 percent gray) was turning back to my younger hair color of dark brown. Currently, almost all of my body hair is dark brown.

I have also noticed that my head hair is getting darker (but at a slower pace than my body hair). I have been concerned that I might have a health issue that is the causative factor. Can you help? -- D.F.

ANSWER: If you and I could figure out how to reliably reverse graying of hair (a phenomenon called repigmentation), we could become wealthy beyond the dreams of avarice. Sadly, nobody has yet succeeding in doing so. I have found some reports of dietary changes (mostly to a more plant-based diet) seeming to cause this reversal. Various supplements claiming to do this are offered for sale online; however, there is no reliable evidence that they work.

There are case reports of some medications causing repigmentation. None of the medications are ones that I would recommend or consider safe for this use. The best studied probably is acitretin, a vitamin A derivative.

I also found case reports of hair color returning in a localized area after shingles and in one case of melanoma, but these are unlikely to be the cause in you. I would look at any medications you might be taking, and see if any have been associated with repigmentation.

DEAR DR. ROACH: I have a question about high HDL. On my last lab test results, my numbers were: total cholesterol 231, HDL 161, LDL 59, triglycerides 53. Is this 161 too high? If so, what do I do about it? My primary care doctor did not comment. -- M.D.

ANSWER: In general, the higher the HDL, the lower the risk of heart disease. 161 is one of the highest I have ever heard of. I would expect your heart disease risk to be lower than average. It is debated whether it's the HDL itself that causes the lower risk, since medications that just raise HDL have not reduced heart disease risk.

I did read a few years ago of a subgroup of people with high HDL who had an increased risk of heart disease. This group also had a high C-reactive protein level, indicating ongoing inflammation. If you have a family history of heart disease despite a high HDL level, I would talk to your doctor about testing your C-reactive protein.

READERS: The booklet on herpes and genital warts explains these two common infections in detail. Readers can obtain a copy by writing: Dr. Roach -- No. 1202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow 4-6 weeks for delivery.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/02/12/check-doctor-checkup-schedule/feed/0E-cigarettes are not a harmless replacement for tobaccohttp://health.heraldtribune.com/2015/02/10/e-cigarettes-not-harmless-replacement-tobacco/
http://health.heraldtribune.com/2015/02/10/e-cigarettes-not-harmless-replacement-tobacco/#commentsTue, 10 Feb 2015 16:19:36 +0000http://health.wp.htcreative.com/?p=23922Read more »]]>Q: My husband has been puffing on e-cigarettes for over a year, and he’s pretty much given up tobacco. I’m grateful, but I’d like him to give up the gadget, too. Can you give me some ammunition? — Audrey S., Saugerties, New York

A: Absolutely. E-cigarettes are not harmless, although they are currently unregulated.

Different brands and types of e-cigs contain varying levels of toxins. A new study for the Japanese Ministry of Health found that some e-cig vapors contained 10 times more formaldehyde than regular tobacco smoke, and formaldehyde is a very potent carcinogen. Puffing a lot on the device can overwork the heating element, releasing additional toxins (there even have been reports of e-cigarettes exploding).

A University of South California study found that some e-cigarettes contain four times more nickel than tobacco cigarettes, plus chromium (which is not found in regular smokes). Replacement cartridges may contain lead, zinc and other toxic metals.

Although they are found at lower levels than in tobacco cigarettes, they’re still NOT good for you!

Q: I’m 40 years old, but my doctor says I’m at risk for heart problems! I thought that before menopause women were protected from those sorts of issues. I’m only a little overweight (15 pounds), and I don’t think of myself as unhealthy. Is my doctor just trying to stir up business? — Sally G., Medina, Ohio

A: We would say that your doctor is trying to save your life. Heart disease is the leading cause of death for women in the U.S. And while it’s true that traditionally we thought premenopausal women were protected from heart disease, that was before the epidemic of obesity and diabetes changed women’s health equation.

A recent study looked at info on more than 69,000 women and found that in your age group, an astounding 75 percent of heart attacks could be prevented by following these smart-living steps:

Clear the pantry of prepared foods with added sugars or syrups and all grains that aren’t 100 percent whole, and make healthy eating a fun family project. Restock your kitchen with fresh fruits, veggies and ONLY lean protein from skinless chicken and fish (salmon and ocean trout are especially healthy).

And then make physical activity fun for the whole family. Take a walk together after dinner and do action video games (Wii Fit or Dance Dance Revolution).

]]>http://health.heraldtribune.com/2015/02/10/e-cigarettes-not-harmless-replacement-tobacco/feed/0Pelvic pain source can go undiagnosed for yearshttp://health.heraldtribune.com/2015/02/04/pelvic-pain-source-can-go-undiagnosed-years/
http://health.heraldtribune.com/2015/02/04/pelvic-pain-source-can-go-undiagnosed-years/#commentsWed, 04 Feb 2015 10:00:02 +0000http://health.wp.htcreative.com/?p=23761Read more »]]>DEAR DR. ROACH: I developed pudendal neuralgia several years ago (confirmed by rectal EMG), and am unable to sit for any length of time. The majority of my pain is in the peri-anal area and into the testicles. This happened after I was misdiagnosed following an ankle injury and was very sedentary for three months (sitting most of the time), which caused compression of the nerve.

Physical therapy (deep-tissue massage, ultrasound, laser) has helped. I take Lyrica and Cymbalta, and wear a Butrans patch. More than a dozen nerve blocks were not helpful, although the past block seems to have lessened the pain to some extent. I also have undergone dry needling for trigger points and internal massage of the pudendal nerve. Acupuncture did not help. Are you aware of any other treatments that may help with this problem? -- G.M.

ANSWER: The pudendal nerve moves in a complex way through the pelvis, and can be damaged in several ways, including through pelvic surgery, but I most often see it in male cyclists. The typical symptoms are pain in the perineum, but pain can be in many areas around the pelvis, and may be more of an electric shock sensation or numbness rather than pain.

Some people are incorrectly diagnosed for years, as this is an uncommon disorder. You already have had many of the treatments for it, including physical therapy, medications and nerve blocks (which can help with diagnosis as well). In people with insufficient relief after as much as you have been through, I would recommend that you consider pudendal nerve decompression surgery. This is a situation where several surgical techniques can be used, and having an experienced surgeon is of paramount importance. Most people have at least a 50 percent reduction in pain with surgery, but there is no guarantee of a perfect outcome.

DEAR DR. ROACH:After reading your article regarding symptoms of basal cell skin cancer, I found the information extremely helpful, but would like to add my history of a very serious basal cell issue. It was on my nose, about the size of a quarter and required Mohs surgery followed by cartilage and forehead skin transplant -- ultimately requiring three separate surgeries. The reason this cancer became so severe was that I and my doctor were unable to differentiate between the cancer and psoriasis. I did further damage by intentionally sitting in the sun during the noon hour for about a week, thinking I was treating psoriasis.

I am writing this to you in case you touch on this subject in a later column. Those with psoriasis breakouts on the face should be checked for basal cell cancer. I had only mild psoriasis patches previously on my face, and the basal cell really looked identical to what I had seen. The difference was bleeding, which would start and stop. My regular physician assumed it was psoriasis. It was only when I called it to his attention that he said I needed to be rechecked by the dermatologist. -- G.F.H.

ANSWER: Thank you for writing. This is a great reminder that skin cancers can look like benign conditions, and that bleeding is a big red flag. Patients and primary-care doctors should be vigilant and schedule a dermatology visit for nonhealing lesions.

READERS: The booklet on sodium, potassium chloride and bicarbonate explain the functions of these body chemicals and how low or high readings are corrected. To obtain a copy, write: Dr. Roach -- No. 202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/02/04/pelvic-pain-source-can-go-undiagnosed-years/feed/0It pays to check into lower-cost medshttp://health.heraldtribune.com/2015/02/03/pays-check-lower-cost-meds/
http://health.heraldtribune.com/2015/02/03/pays-check-lower-cost-meds/#commentsTue, 03 Feb 2015 15:48:47 +0000http://health.wp.htcreative.com/?p=23759Read more »]]>DEAR DR. ROACH: My husband recently was diagnosed with ulcerative colitis. He was prescribed Lialda, and also was told that he would have to take it for the rest of his life. He is scheduled for another colonoscopy in a few weeks.

This is a very expensive medication. We are senior citizens with a limited income. It seems there is a generic form of Lialda; however, his doctor did not prescribe it for him. He is feeling somewhat better on it. I know he is concerned about how he will be able to pay for it. His dosage started with four pills a day. His doctor has lowered it to three at this time.

Is there a less-expensive medication available? His first prescription two months ago put him in the doughnut hole. The first of the new year, he will be ready for a refill.

If there is any advice you can give us about our new condition, we would really appreciate it, as it is quite overwhelming for us at this time. We will have to live with it and manage it as we go. -- Anon.

ANSWER: Ulcerative colitis is one type of inflammatory bowel disease (the other type is Crohn's disease). It causes inflammation and ulcers in the colon, and increases long-term risk of colon cancer.

Lialda is a brand name of mesalamine, also called 5-ASA, which reduces inflammation in the colon. I would ask your husband's doctor about an old formulation of 5-ASA called sulfasalazine. According to my sources, in the U.S. Lialda is about $970 per month, and sulfasalazine is about $45 per month. Sulfasalazine is more likely to have side effects; however, one study showed that it is slightly more likely to prevent flares of ulcerative colitis. If he can tolerate the sulfasalazine, then that might be the best way to go.

DEAR DR. ROACH: I am a 50-year-old female. How accurate are the results of fecal blood tests? In May, then July, I saw what looked like blood in my stool. My GP ordered the fecal blood test, three smears over three days. Results negative. Then in November I saw it again. My doctor said since the fecal test showed no blood, there is no blood.

My sister had colon cancer at age 45. I have had pre-cancerous polyps removed every three years for the past 10 years. Can I trust the fecal blood test results? -- S.C.

ANSWER: The fecal occult blood test uses an enzyme that causes a color change in the presence of heme, a component of hemoglobin, the major protein in blood. Although the fecal blood results are pretty accurate, they can be erroneous in two ways: a false positive and a false negative.

A false positive means the stool test is positive when there is no blood. This can happen from eating raw vegetables (many types, especially turnips and radishes) and meat. A false negative can happen in the presence of large amounts of vitamin C, but more importantly, many lesions of the colon, including colon cancer, bleed only intermittently. In my opinion, someone with a history like yours, including precancerous polyps and a family history of colon cancer, should have a colonoscopy as the screening test rather than stool cards.

The booklet on colon cancer provides useful information on the causes and cures of this common malady. Readers can obtain a copy by writing: Dr. Roach -- No. 505, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/02/03/pays-check-lower-cost-meds/feed/0Source of canker sores is unclearhttp://health.heraldtribune.com/2015/01/29/source-canker-sores-unclear/
http://health.heraldtribune.com/2015/01/29/source-canker-sores-unclear/#commentsThu, 29 Jan 2015 10:00:51 +0000http://health.wp.htcreative.com/?p=23670Read more »]]>DEAR DR. ROACH: I am plagued with canker sores. I get four to five outbreaks a year. The products that are sold to heal them do not help much. Do you know of a mouthwash that could be used to prevent or maybe reduce the severity of canker sores, and what would you recommend for use on canker sores? What, in your opinion, causes them? -- J.H.

ANSWER: Canker sores, also called aphthous ulcers, are painful sores that are located in the mouth. When they keep coming back, as in your case, it is called recurrent aphthous stomatitis ("stoma" is the Greek word for "mouth," and is sometimes used for surgically created openings). While it isn't clear why they occur, there have been studies that show there may be a defect in immune function in people with RAS, making it similar to Behcet's syndrome. It may be associated with celiac disease and inflammatory bowel disease, and it can be triggered by many things, including stress, food and drug hypersensitivity and trauma.

The most common effective treatment I know of is a medium- or high-potency topical steroid. It can be prepared specifically for use on aphthous ulcers, such as Kenalog in Orabase, and this can speed up healing, especially when applied early. Some people swear by vitamins, but they were not found to be effective in a study.

Thalidomide, a potentially dangerous medication that has extremely high risk for birth defects, can be used in severe cases.

DEAR DR. ROACH: I offer my experience with a prostate treatment not covered in your article. I had no symptoms. A routine annual test revealed that my PSA had risen rapidly to 5.1. At the recommendation of my urologist, I had a biopsy (actually, 13 individual biopsies). My Gleason score of 7/8 predicted a painful death from prostate cancer if left untreated.

My options were surgery or radiation therapy. I chose radiation, which consisted of nine weeks (45 treatments) of one or two minutes of actual radiation. Extreme caution was taken to avoid damage to other organs. I had no side effects during or after treatment. Two years later, my PSA is 0.04, and I expect to continue an active lifestyle at 82 years of age. -- J.A.G.

ANSWER: I appreciate you writing in to share your story. Most men I hear from have accepted surgery in your situation; however, many experts feel that radiation treatment offers a better balance of effectiveness and side effects than surgery. I did know an oncologist in a situation almost exactly like yours who also decided on radiation and had excellent results.

I do want to caution that a perfect outcome like yours is not guaranteed. I occasionally see men who, despite abundant caution, have developed radiation damage to the rectum or bladder. However, the risks with modern radiation therapy are low.

DEAR DR. ROACH:I have been diagnosed with positional vertigo. My doctor has me doing Cawthorne head exercises. Have you heard of these? Do they work? -- M.M.S.

ANSWER: Vertigo is an abnormal sense of motion while still. Many people describe it as a "spinning" sensation, but others feel it differently. The most common cause probably is benign paroxysmal positional vertigo, and rehabilitation exercises, such as the Cawthorne-Cooksey exercises, are very effective. Although medication is frequently prescribed, I recommend strongly against long-term use of medication, which can slow down or stop healing.

Although you can do the exercises on your own, I recommend learning how to do them properly and safely with an occupational or physical therapist.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/01/29/source-canker-sores-unclear/feed/0Geographic tongue is both common and benignhttp://health.heraldtribune.com/2015/01/28/geographic-tongue-common-benign/
http://health.heraldtribune.com/2015/01/28/geographic-tongue-common-benign/#commentsWed, 28 Jan 2015 10:00:06 +0000http://health.wp.htcreative.com/?p=23668Read more »]]>DEAR DR. ROACH: I am generally healthy, but my one problem is my tongue. I have a condition called geographic tongue, and it is white, patchy and with gashes. Some days it is fine and normal. Why is this happening? -- A.P.

ANSWER: While geographic tongue, also called benign migratory glossitis, is not as uncommon as you might think, it's a complete mystery as to why it occurs. The lesions on the tongue can look like ulcers, and they come and go over hours or even minutes. Many people have exacerbations and remissions of the lesions, but they usually are asymptomatic, or may have some discomfort or burning sensation.

Geographic tongue can be misdiagnosed as a fungal infection, which can lead to ineffective and unnecessary treatment. Most people need nothing more than reassurance that it is both common and benign.

DEAR DR. ROACH:Our over-55 community has a fitness center that is well-attended. Management provided spray bottles containing water and hydroxyalkyl amine oxide. We are encouraged to spray (soak) and wipe down each machine, the backrest, seat, handholds and weight-pin changers after use. Sweat stains are not an issue in most cases. Is this sanitation effort really necessary to maintain good health? -- G.D.

ANSWER: I would consider the risks of using the product against the risks of not using the product. Hydroxyl amine oxides are common detergents used in many cleaning products. Although they are classified as skin irritants, at low concentration, such as from a spray bottle, most people do not have a skin reaction to them. They are effective at killing most germs.

However, there just aren't a lot of germs capable of causing disease that we carry around with us and could spread through sweat. If I were about to use the exercise equipment, I think I would prefer a wipe-down from a clean towel in between users, and reserve the spray detergent for the end of the day.

DEAR DR. ROACH:I was diagnosed with pancreatic cysts. A recent MRI scan showed that they are less than 2 cm and have been stable for a year. My doctor tells me these are benign and don't need any more follow-up. Could these cysts become cancerous later on? -- K.

ANSWER: The medical term "cyst" means any fluid-filled, walled structure. They can occur in practically any anatomic location you can think of. In the pancreas, there are several types of cysts, as well as pseudocysts (fluid collections, usually as a result of pancreatitis, that develop a wall after some weeks), and cystic neoplasms, which have the potential to become cancerous.

You didn't tell me how you were diagnosed. Very often, these are found incidentally when a CT scan is obtained for some other reason. In this case, when there are no symptoms present, the only concern is whether they can grow and cause symptoms later on, or worse yet, could become cancerous. Since pancreatic cancer is justifiably feared, I understand your reasons for asking the question.

Fortunately, I agree with your doctor completely. The likelihood of a small cyst (your largest cyst is 1.4 cm) being cancer is less than 5 percent. Since it hasn't changed in a year of follow-up, your risk for cancer is very, very low.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/01/28/geographic-tongue-common-benign/feed/0Rare cancer of the blood moves swiftlyhttp://health.heraldtribune.com/2015/01/26/rare-cancer-blood-moves-swiftly/
http://health.heraldtribune.com/2015/01/26/rare-cancer-blood-moves-swiftly/#commentsMon, 26 Jan 2015 10:00:49 +0000http://health.wp.htcreative.com/?p=23666Read more »]]>DEAR DR. ROACH:On a Monday, I took my 91-year-old mother out for a belated birthday lunch. She has had a long and, until now, fairly healthful life. She still had her driver's license and thought nothing of driving the 70 miles between her house and mine.

She mentioned that she was having a little trouble catching her breath after walking from my car, up a few steps, and into the restaurant. This is the first time that she has had this problem.

She went to the doctor on Thursday. He had my sister take her to the emergency room for some precautionary tests and blood panels. They said she had a touch of pneumonia and were keeping her overnight for observation.

Around 10 p.m., my sister called and asked if I could come because the news was worse than originally thought. She told me that Mom had acute T-cell leukemia and only had a few days to a week to live! Later, when I called to check on Mom, my sister said they were sending her home that night on full oxygen and with hospice and 24-hour nursing care. All this in a little over 30 hours! On Saturday, Mom passed away. Luckily she slept most of the day on medication to ease her breathing and wasn't in any pain.

Her primary care physician (whom she had for over 20 years) told us that her blood work for the previous six months showed nothing out of the ordinary. In less than a week, this vibrant woman went from enjoying lunch out with a daughter to passing away in her own home with her two daughters by her side.

I guess my question is: What can you tell us about this fast-acting leukemia? Where does it come from, how does it strike? -- B.A.

ANSWER: I am very sorry to hear about your mother. She had an unusual situation. Acute T-cell prolymphocytic leukemia is a rare leukemia of older adults. The word "leukemia" comes from "leuko-," meaning "white," and "heme," which means "blood." So, it's too many white cells in the blood. This is a type of cancer of white blood precursors in the bone marrow, and at the time people come to medical attention, the white cell count can be 10 or 20 times the normal amount. Unfortunately, the white cells, which normally fight off infection, are not normal and people are at higher risk for infection. More importantly, the bone marrow is so full of cancer cells that the normal red blood cells and platelets made by the bone marrow are reduced.

Although many leukemias are curable now, this is not one of them. Most people with this condition have less than a year to live, but your mother's course is unusually fast even for this rare disease. We don't know why this disease attacks certain people.

I do want to say a word of thanks for hospice workers, the physicians, nurses and staff who, in my extensive experience, are almost without exception truly dedicated, giving people who help people in the last stages of many diseases pass with dignity and peace. They do patients and their families a wonderful service.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/01/26/rare-cancer-blood-moves-swiftly/feed/0Prevention is still key in many cancershttp://health.heraldtribune.com/2015/01/13/prevention-still-key-many-cancers/
http://health.heraldtribune.com/2015/01/13/prevention-still-key-many-cancers/#commentsTue, 13 Jan 2015 15:38:14 +0000http://health.wp.htcreative.com/?p=23564Read more »]]>Q: Scientists are now saying that it’s just your bad luck if you get cancer. Is everything we’ve heard about prevention now wrong?

A: It may sound flippant to say that many cases of cancer are caused by bad luck, but that is what two scientists suggested in the journal Science.

The bad luck comes in the form of random genetic mistakes, or mutations, that happen when healthy cells divide.

Random mutations may account for two-thirds of the risk of many types of cancer, leaving the usual suspects — heredity and environmental factors — to account for only one-third, say the authors, Cristian Tomasetti and Dr. Bert Vogelstein, of Johns Hopkins University.

“We do think this is a fundamental mechanism, and this is the first time there’s been a measure of it,” said Tomasetti, an applied mathematician.

Though the researchers suspected chance had a role, they were surprised at how big it turned out to be.

“This was definitely beyond my expectations,” Tomasetti said. “It’s about double what I would have thought.”

The finding may be good news to some people, bad news to others, he added.

Smoking greatly increases the risk of lung cancer, but for other cancers, the causes are not clear. Yet many patients wonder if they did something to bring the disease on themselves, or if they could have done something to prevent it.

“For the average cancer patient, I think this is good news,” Tomasetti said. “Knowing that overall, a lot of it is just bad luck, I think in a sense it’s comforting.” Among people who do not have cancer, Tomasetti said he expected there to be two camps.

“There are those who would like to control every single thing happening in their lives, and for those, this may be very scary: ‘There is a big component of cancer I can just do nothing about,’ ” he said. “For the other part of the population, it’s actually good news: ‘I can of course do all I know that’s important to not increase my risk of cancer . . . but on the other side, I don’t want to stress out about every single thing or every action I take in my life, or everything I touch or eat.’ ”

Vogelstein said the question of causation had haunted him for decades, since he was an intern and his first patient was a 4-year-old girl with leukemia. Her parents wanted to know what had caused the disease.

He had no answer, but time and time again heard the same question, particularly from parents.

“They think they passed on a bad gene or gave them the wrong foods or exposed them to paint in the garage,” he said. “And it’s just wrong. It gave them a lot of guilt.”

Tomasetti and Vogelstein said the finding that so many cases of cancer occur randomly means there should be more emphasis on developing better tests to find cancers early enough to cure them.

“Cancer leaves signals of its presence, so we just have to basically get smarter about how to find them,” Tomasetti said. Their conclusion comes from a statistical model using data on rates of cell division in 31 types of tissue. The analysis did not include breast or prostate cancers, because there was not enough data on those tissues. Dr. Kenneth Offit, chief of the clinical genetics service at Memorial Sloan Kettering Cancer Center, called the article “an elegant biological explanation of the complex pattern of cancers observed in different human tissues.”

He said the hypothesis “appears to be correct,” but added that it is “just a first approximation,” and noted that certain types of cancer did not fit the model.

Although the article focused on factors beyond people’s control, Offit said about half of cancer deaths can be avoided.

“The most powerful interventions to decrease the burden of cancer are to stop smoking, know your family history and aim for ideal weight,” he said.

– Denise Grady, The New York Times

]]>http://health.heraldtribune.com/2015/01/13/prevention-still-key-many-cancers/feed/0What dreams may come (from your meds)http://health.heraldtribune.com/2015/01/09/dreams-may-come-meds/
http://health.heraldtribune.com/2015/01/09/dreams-may-come-meds/#commentsFri, 09 Jan 2015 10:00:22 +0000http://health.wp.htcreative.com/?p=23450Read more »]]>DEAR DR. ROACH:I am 90 years old and take many medications. I am having many different dreams at night. Can medications cause this? -- A.C.

ANSWER: Pretty much whenever I get the question, "Can medications cause this?" the answer is "yes." In your case, it's very clear that some medications cause unusual dreams in many people who take them. Antibiotics, antidepressants, blood pressure medications and even sleeping medications can cause remarkable dreams. Some people hate this side effect; others enjoy it. Knowing that medications could be causing them often is a source of relief.

I would caution you not to stop your medications suddenly or without talking to your doctor. You should go over your list of medicines and try to discover which are the most likely to be the source. Sometimes, a medicine can be stopped if the dreams are very bothersome.

DEAR DR. ROACH:A good friend of mine has an unusual problem. Every time he eats fresh tomatoes, he gets pimples. Is this an allergy? It never fails to cause pimples. -- E.D.

ANSWER: Yes, I have heard that before. Fresh tomatoes, but not cooked ones, seem to cause some people to have an acne breakout, at any age. Other acidic foods, especially citrus, seem to cause that reaction, too. It's not a true allergy.

Acne is a complex condition, and it starts with a hair follicle being blocked by excessive skin cell growth, causing a plug in the follicle. This allows skin bacteria, Propionibacterium acnes, to grow in the oily substance normally used to lubricate the skin and hair follicle. It's called sebum. While there is some evidence that diet can worsen acne, it isn't exactly clear how that works. Most cases of adolescent acne are primarily due to the hormonal changes causing increased sebum production.

DEAR DR. ROACH:I am a 62-year-old man who likes to ride his bicycle for exercise. I ride on paved trails and streets, approximately 10 miles at a time with an eye on extending the length of my rides. I own a road bike, but currently I ride a bike that provides a somewhat more upright seating position. In either case, the seat is narrow and firm. My body is in a forward-leaning position while riding.

My question for you is, Should I be concerned with my prostate gland or any other body parts in that general area? I wear padded bicycle shorts when riding. I have annual physicals, and I am not aware of any problems. I do have an older brother who is going through radiation treatment for prostate cancer, and he used to ride to and from his work. His rides were not extreme.

I have read cautionary reports from the bike community about such things, but they seem to focus on the more exposed body parts. Lance Armstrong comes to mind in this regard. -- Anon.

ANSWER: There is research looking at three areas of men's health with regard to cycling: prostate, sexual dysfunction and testicular cancer. The results suggest no or very small increased risk in prostate cancer or sexual dysfunction. However, some bike saddles and riding positions do put pressure on the nerves and arteries that supply the penis. Finding a comfortable saddle that doesn't cause numbness, avoiding very long rides and standing up periodically on the pedals can prevent problems. Biking shorts help most people.

Although some early studies did link cycling with testicular cancer, most authorities now believe there is no link between testicular cancer and bicycling. In fact, regular exercise reduces risk of both testicular and prostate cancer.

READERS: The booklet on stroke explains this condition that is deservedly feared by all. Readers can obtain a copy by writing: Dr. Roach -- No. 902, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/01/09/dreams-may-come-meds/feed/0Sideroblastic anemia has more than one causehttp://health.heraldtribune.com/2015/01/08/sideroblastic-anemia-one-cause/
http://health.heraldtribune.com/2015/01/08/sideroblastic-anemia-one-cause/#commentsThu, 08 Jan 2015 10:00:55 +0000http://health.wp.htcreative.com/?p=23448Read more »]]>DEAR DR. ROACH: I am 92 and consider myself very fortunate, health-wise. In the middle of the 1980s, I was diagnosed with sideroblastic anemia. My doctor in Florida did many tests to make the diagnosis and to figure out why my hemoglobin level went up and down.

I moved to Mississippi, and the doctor here referred me to the cancer center. In a two-week period, my hemoglobin went from 10.2 to 8. I felt no different, and have not been treated for anemia. Do you have any comment? -- R.W.G.

ANSWER: Sideroblastic anemia, despite its precise-sounding name, can be any of a number of conditions that have an abnormal red blood cell with a nucleus and iron-rich granules ("sidero" is Greek for "iron," and "blast" means "an immature cell"). There are reversible causes, such as some medications or alcohol; copper deficiency; congenital causes, often due to mitochondrial diseases; and the most likely cause in you, refractory anemia with ring sideroblasts.

Many people who have refractory anemia with ring sideroblasts do not need treatment. Sometimes, blood transfusions are necessary. There is also a medication called azacitidine that helps some people with your condition.

Hemoglobin levels vary from day to day, but a two-point drop in two weeks is concerning. Your doctor will recheck the level, and if it is a real drop, he or she may want to do further testing.

DEAR DR. ROACH: My bloodwork showed my bilirubin number going up to 1.8, then 2.1. A CT scan showed no abnormalities with the liver. I have no symptoms, but my doctor said that if the number stays up, he will refer me to a specialist.

I am concerned that because I have taken a lot of Tylenol over the years, I may have caused liver damage. Also, I have taken an enzyme for lactose intolerance and am concerned that may have caused this problem. -- A.W.

ANSWER: Bilirubin is a breakdown product of heme, a protein in blood and, to a smaller degree, muscle. Heme is metabolized by the liver to bilirubin. A high level of bilirubin in the blood can come from excess breakdown of blood or muscle, or from an inability of the liver to metabolize it. There is a familial condition present in 4 percent to 16 percent of the population, Gilbert syndrome, in which bilirubin level is high, but this is a benign condition.

Acetaminophen (Tylenol) can cause liver damage when taken in very large doses, and it also can cause kidney disease with chronic use; however, it's unlikely to have anything to do with your elevated bilirubin level if there are no other liver problems found by blood testing and imaging.

Lactase, an enzyme used by many people with an inability to break down the sugar in milk, is very safe. You may have been misled because some of the blood tests we obtain to look at liver function are enzymes, such as the ALT and AST levels.

Most people I see with no symptoms and an elevated bilirubin level have no liver disease, but a referral to a specialist may be reassuring.

DEAR DR. ROACH: I am 73 years old, with osteoporosis and scoliosis. Can scoliosis be corrected? -- W.E.W.

ANSWER: Osteoporosis is loss of strength of the bones, and scoliosis is a curvature of the spine. They may or may not be related. The osteoporosis should be treated, but the scoliosis usually does not need to be treated. Muscle strengthening exercises are important, and braces and injections may be used. Surgery is reserved for very severe cases, particularly in adults.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

We had just finished our endocrine unit when I noticed a lump in my neck. Perhaps school had made me more vigilant, or perhaps I merely fell into the realm of hypochondriac medical student, but I couldn’t ignore this lump.

Medical student Cherie Fathy’s brush with cancer “humbled” her in her interactions with patients. (Courtesy of Cherie Fathy.)

I set up an appointment with my doctor, fully expecting a diagnosis of what’s sometimes called medical student neuroticism. Instead, she agreed it was a peculiar lump, and though she believed that it would ultimately prove to be nothing, she was ordering some tests. I approached the tests as an educational experience, something that would make for a good story.

And then one day as I was studying in the library, I found I was having a hard time focusing on anything but the lump. I felt an overwhelming need to check the results of the ultrasound that had been done, so I shakily typed in my password to access the test results; I scanned the radiologist’s note until I landed upon the words “biopsy recommended.”

I guess I hadn’t realized just how much I had compartmentalized the experience until I read those words over and over again. With my face red from crying, I quickly gathered my things and ran home. Do I tell my father? Do I tell my friends? It could still be nothing.

The first two years of medical school, the preclinical years, teach students about disease in the abstract, as testable material. I have been guilty of occasionally forgetting that what I am studying may be a patient’s worst nightmare.

We are there as patients receive a diagnosis in the clinic or a treatment in the hospital. What we don’t see is a patient at home deciding whether that lump is even worth checking on or a mother dreading to tell her children what she has.

A full two months after my initial doctor’s visit, time that was filled with scans and biopsies, I received a phone call that confirmed my worst fear. I had thyroid cancer. The news shattered my sense of invincibility that, as a 20-something, I had taken for granted.

My type of thyroid cancer has around a 95 percent long-term survival rate. Knowing that did little to quell the emotional haze that set over me.

Ironically, I still remember the first time I heard this number. Our professor held up a thyroid specimen and pointed to the cancer, stating, “If you ever get a cancer, this is the one you want.” At the time, I found that tremendous. Almost everyone lives! Now, I struggled to find solace in those words.

You see, patients will play odds and measure risk in very different ways than we may expect them to as physicians. In my mind, I was already the one person out of 10 who did not have a benign thyroid nodule. That I was the one person out of 10 made me look at almost every situation through a lens of “what if’s.” I constantly feared that any rare side effect would become a reality for me.

As a medical community, we ask patients to take on risks in order to heal, but we should never forget how overwhelming it is to hear those risks or to play those odds.

I wish I could say that my experience last year has revolutionized how I speak with sick patients, that I always know exactly what to say or when to say it. But I don’t.

My brush with cancer has, however, humbled me in my interactions with patients. I try never to assume that just because I know the medical facts, I understand how a patient is going to interpret them.

Ultimately, learning about a disease is incredibly different from living it.

]]>http://health.heraldtribune.com/2015/01/06/med-student-turns-patient/feed/0The cause of most cancers is ... bad luck?http://health.heraldtribune.com/2015/01/06/cause-cancers-bad-luck/
http://health.heraldtribune.com/2015/01/06/cause-cancers-bad-luck/#commentsTue, 06 Jan 2015 14:26:47 +0000http://health.wp.htcreative.com/?p=23487Read more »]]>It may sound flippant to say that many cases of cancer are caused by bad luck, but that is what two scientists suggested in an article published last week in the journal Science. The bad luck comes in the form of random genetic mistakes, or mutations, that happen when healthy cells divide.

Random mutations may account for two-thirds of the risk of getting many types of cancer, leaving the usual suspects — heredity and environmental factors — to account for only one-third, say the authors, Cristian Tomasetti and Dr. Bert Vogelstein, of Johns Hopkins University School of Medicine.

This undated image provided by the U.S. National Cancer Institute shows the 46 human chromosomes, where DNA resides and does its work. Each chromosome contains genes, but genes comprise only 2 percent of DNA. On Wednesday, Sept. 5, 2012, 500 scientists around the world reported their findings on the complex functions occurring in the rest of DNA, much of it involved in regulating genetic activity. (AP Photo/National Cancer Institute)

“We do think this is a fundamental mechanism, and this is the first time there’s been a measure of it,” said Tomasetti, an applied mathematician.

Though the researchers suspected that chance had a role, they were surprised at how big it turned out to be.

“This was definitely beyond my expectations,” Tomasetti said. “It’s about double what I would have thought.”

The finding may be good news to some people, bad news to others, he added.

Smoking greatly increases the risk of lung cancer, but for other cancers, the causes are not clear. And yet many patients wonder if they did something to bring the disease on themselves, or if they could have done something to prevent it.

“For the average cancer patient, I think this is good news,” Tomasetti said. “Knowing that overall, a lot of it is just bad luck, I think in a sense it’s comforting.”

Among people who do not have cancer, Tomasetti said he expected there to be two camps.

“There are those who would like to control every single thing happening in their lives, and for those, this may be very scary,” he said. " ‘There is a big component of cancer I can just do nothing about.’

“For the other part of the population, it’s actually good news. ‘I’m happy. I can of course do all I know that’s important to not increase my risk of cancer, like a good diet, exercise, avoiding smoking, but on the other side, I don’t want to stress out about every single thing or every action I take in my life, or everything I touch or eat,’ ”

Vogelstein said the question of causation had haunted him for decades, since he was an intern and his first patient was a 4-year-old girl with leukemia. Her parents were distraught and wanted to know what had caused the disease. He had no answer, but time and time again heard the same question from patients and their families, particularly parents of children with cancer.

“They think they passed on a bad gene or gave them the wrong foods or exposed them to paint in the garage,” he said. “And it’s just wrong. It gave them a lot of guilt.”

Tomasetti and Vogelstein said the finding that so many cases of cancer occur from random genetic accidents means that it may not be possible to prevent them, and that there should be more of an emphasis on developing better tests to find cancers early enough to cure them.

“Cancer leaves signals of its presence, so we just have to basically get smarter about how to find them,” Tomasetti said.

Their conclusion comes from a statistical model they developed using data in the medical literature on rates of cell division in 31 types of tissue. They looked specifically at stem cells, which are a small, specialized population in each organ or tissue that divide to provide replacements for cells that wear out.

Dividing cells must make copies of their DNA, and errors in the process can set off the uncontrolled growth that leads to cancer.

The researchers wondered if higher rates of stem-cell division might increase the risk of cancersimply by providing more chances for mistakes.

Vogelstein said research of this type became possible only in recent years, because of advances in the understanding of stem-cell biology.

The analysis did not include breast or prostate cancers, because there was not enough data on rates of stem-cell division in those tissues.

A starting point for their research was an observation made more than 100 years ago but never really explained: Some tissues are far more cancer-prone than others. In the large intestine, for instance, the lifetime cancer risk is 4.8 percent — 24 times higher than in the small intestine, where it is 0.2 percent.

The scientists found that the large intestine has many more stem cells than the small intestine, and that they divide more often: 73 times a year, compared with 24 times. In many other tissues, rates of stem cell division also correlated strongly with cancer risk.

Some cancers, including certain lung and skin cancers, are more common than would be expected just from their rates of stem-cell division — which matches up with the known importance of environmental factors like smoking and sun exposure in those diseases. Others more common than expected were linked to cancer-causing genes. To help explain the findings, Tomasetti cited the risks of a car accident. In general, the longer the trip, the higher the odds of a crash. Environmental factors like bad weather can add to the basic risk, and so can defects in the car.

“This is a good picture of how I see cancer,” he said. “It’s really the combination of inherited factors, environment and chance. At the base, there is the chance of mutations, to which we add, either because of things we inherited or the environment, our lifestyle.”

Dr. Kenneth Offit, chief of the clinical genetics service at Memorial Sloan Kettering Cancer Center in Manhattan, called the article “an elegant biological explanation of the complex pattern of cancersobserved in different human tissues.”

He said the hypothesis “appears to be correct,” but added that it is “just a first approximation,” and he noted that certain types of cancer did not fit the model. One form of thyroid cancer, for instance, has a much bigger hereditary component than the model would suggest, he said.

Although the article focused on factors in cancer beyond people’s control, Offit said that about half of cancer deaths could be avoided.

“So one would not want to dilute the important public health message that although most cancer is likely due to random events (affecting DNA replication) at the cellular level, at the population level, the most powerful interventions to decrease the burden of cancer are to stop smoking, know your family history and aim for ideal weight,” he said.

ANSWER: I thought I knew supplements pretty well, but hadn't heard of monatomic gold. Monatomic gold is supposed to be an "orbitally rearranged monoatomic element." In fact, these don't exist chemically, and anyone selling a product like this and claiming health benefits is deliberately scamming you or is confused. Metallic gold is inert and has no effect in the body, as opposed to gold salts, which are powerful and potentially dangerous medications, now seldom used for rheumatic diseases. Avoid "monatomic gold" supplements.

DEAR DR. ROACH:My primary care doctor hasn't been able to answer this. What are the pros and cons of having shingles vaccine if one has genital herpes and is being treated with acyclovir? I'm in my 60s. -- A.A.

ANSWER: The potentially confusing issue is that genital herpes is caused by herpes simplex virus II, which is in the same family of viruses as varicella-zoster virus, the cause of shingles. However, the vaccine will have no effect on the herpes or its treatment, so you have the same recommendation as the average person, which is to get the vaccine. Anyone over 60 should have the vaccine unless there is a reason he or she can't get it, such as having a serious immune system disease (like advanced HIV), being on medications that suppress the immune system, or having recently had cancer chemotherapy.

DEAR DR. ROACH:I am a post-menopausal woman with a BRCA-2 mutation. I had a prophylactic hysterectomy and oophorectomy eight years ago and am involved in a familial cancer program at a major cancer center. As part of this monitoring, along with mammograms and breast MRIs, I get a CA-125 blood test every six months. My levels go up and down from 12 to 25, although this is still in the normal range.

My question is whether cortisone injections can cause the CA-125 level to rise. I have had about five injections for bursitis. The CA-125 test is very flawed, and I don't know why the cancer center uses it. -- Anon.

ANSWER: CA (Cancer Antigen) 125 is a protein produced by normal tissues but at a higher amount by some (but not all) ovarian cancers. Levels can be elevated in many conditions, such as with uterine fibroids, endometriosis and liver disease. I could not find cortisone injection as a possible cause in any of my sources.

You are right that the CA-125 test is very flawed when used as a screening test for cancer. Only 3 percent of postmenopausal women with an elevated level (over 30) had ovarian cancer, and about 1 percent of healthy women without cancer will have an elevated level. However, it is useful for following someone with known epithelial ovarian cancer (the usual type of ovarian cancer).

Because you have had your ovaries removed (that's an oophorectomy) and the Fallopian tubes as well (the cells that line the Fallopian tubes are epithelial cells that can give rise to ovarian cancer), your risk for developing ovarian cancer is very, very small, about 1.7 percent in one study. In those rare cases, the lining of the peritoneum is the source of the cancer. Academic cancer centers often still obtain CA-125 levels as part of their research, testing whether it may have use in women in your situation.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/01/06/no-value-monatomic-gold-supplement/feed/0'Hospitalist' is new category of physicianhttp://health.heraldtribune.com/2015/01/01/hospitalist-new-category-physician/
http://health.heraldtribune.com/2015/01/01/hospitalist-new-category-physician/#commentsThu, 01 Jan 2015 10:00:21 +0000http://health.wp.htcreative.com/?p=23396Read more »]]>'DEAR DR. ROACH: I recently spent four days in the hospital for a respiratory infection. I was not admitted to my primary care doctor's service, but had three names on my wristband. When I inquired as to who they were, I was told that they were hospitalists. They would see me and communicate with my primary care physician. I did not see the same doctor more than once in my four-day admission. When I saw my PCP after discharge, he did say he had been in contact with the hospitalists.

Is this common? Who is absorbing the cost? Does my PCP bill for consultation? -- M.M.E.

ANSWER: Hospitalists are specialists in inpatient medicine. Hospitalists typically have no outpatient responsibilities, and spend the entire day in the hospital taking care of admitted patients only. Because they are constantly in the hospital, they usually can see an admitted patient more expeditiously than a doctor with outpatient responsibilities, and they tend to become expert and efficient at managing serious illness requiring hospitalization. Most studies comparing hospitalists with doctors who do both outpatient and inpatient medicine have shown that hospitalists facilitate decreased lengths of stay in the hospital and at least as good medical outcomes. The theory is that by specializing in just inpatient medicine, one can become expert as well as very efficient at using the resources available at a particular hospital.

The potential downside of hospitalists is that the personal knowledge about a particular patient isn't as high. Your PCP knows you -- hopefully very well, if he or she has been taking care of you for a long time. Although your records may be available to the hospitalists, it isn't the same as personal knowledge. That being said, with good communication (both ways) between your doctor and the hospitalists, the quality of care can be excellent.

There is no doubt that the hospitalist model is increasing in prevalence in the U.S. and Canada.

In answer to your question, your insurance company (or the government) pays the hospitalist directly. The PCP does not bill for consultation.

DEAR DR. ROACH:What is Demodex of the eyelashes? Can it affect other parts of the body? Is it deadly? What can be done about this? -- Anon.

ANSWER: Demodex folliculorum is a mite, a small (0.1 mm) arthropod that lives on human skin in hair follicles. There is debate whether they cause disease, specifically inflammation of the eyelids. Most opinions I read suggest that they do not cause disease, but live in the follicle without causing disease. However, there are reports of eye symptoms in some people with more than usual amounts of Demodex, which can be treated with medication. In most people, Demodex is considered part of the normal flora, like the bacteria and fungi we carry around as well.

DEAR DR. ROACH: Whenever someone is ill with most diseases, he or she is usually prescribed a drug or a medicine, or a pharmaceutical product.

Why is it that cancer patients are treated with "chemo," or "chemotherapy," rather than one of the above? Is there a difference, or is it just semantics? Nobody I've asked seems to have an answer. -- D.G.

ANSWER: To be honest, I was confused too, until medical school, where I learned that "chemotherapy" is just another word for a drug or medicine intended to treat a condition. We just normally reserve the term for drugs used to treat cancer. Although we tend to think of the side effects of chemotherapy as horrific, and some certainly are the most toxic substances we ever use, they vary widely in how well they are tolerated.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2015/01/01/hospitalist-new-category-physician/feed/0Prescription frustration is realhttp://health.heraldtribune.com/2014/12/30/prescription-frustration-real/
http://health.heraldtribune.com/2014/12/30/prescription-frustration-real/#commentsTue, 30 Dec 2014 10:00:01 +0000http://health.wp.htcreative.com/?p=23391Read more »]]>DEAR DR. ROACH: I had a very frustrating experience getting a prescription filled. This happens often, though I consistently follow the instructions of my pharmacy and doctor -- phoning to have my prescription renewed a week before I run out, and going as often as is required. Last time, I had to call the doctor on two consecutive days after the pharmacy's faxes failed to get a response.

I would like to know your thoughts on this problem. We who pay our insurance premiums, doctor bills and pharmacy fees seem to be left out of the equation. -- N.H.

ANSWER: I understand your frustration. People who take multiple medications often end up in the pharmacy several days per month (if not per week) getting medications. And if the physician doesn't have the prescription ready so the pharmacist can fill it, it is frustrating. Worse, it is an abuse of your time.

The best advice I can give is to ask the doctor for a three-month supply. Almost all medications can be filled that way, and most insurance companies will allow this. Sometimes it is cheaper to do it that way as well. This can be done through your local pharmacy or through a mail-order pharmacy, depending on the insurance and your preferences. That significantly cuts down on frustration for everybody.

Many physician offices are now using e-prescriptions, which allows the doctor to send the pharmacy the information instantly and with less trouble than a written prescription or fax.

DEAR DR. ROACH: In today's column on osteopenia, you recommend dairy products. Besides leaching out more calcium than is used, dairy is not a "healthy food," according to the Department of Agriculture. -- K.E.

DEAR DR. ROACH:Calcium needs vitamin D and magnesium to be absorbed by the bone. If you don't have these co-factors, the calcium will settle somewhere in your body, just not your bones. A human body can absorb only about 500 mg of calcium at one time. If a person tries to take the full recommended dose all at once (1,200 mg to 1,500 mg), some of that calcium is not going to be absorbed. -- D.B.

ANSWER: The hypothesis that protein leaches calcium from bones -- once scientific dogma and still prevalent on Internet sites, -- recently has been proven untrue. Animal protein increases calcium absorption, so dairy products increase net calcium uptake. The question of whether dairy reduces fracture risk in people with osteoporosis is not completely settled, with inconclusive evidence on both sides. A diet high in dairy calcium and vitamin D did increase bone density in several studies.

Dairy products certainly are not perfect foods. All milk has sugar, and whole milk and most cheeses have relatively high amounts of fat, so it is wise to limit intake. Dairy products are a good source of calcium, but there are other good dietary sources of calcium, such as dark-green, leafy vegetables. I recommend diet rather than calcium supplements due to concerns about cardiovascular health, as well as the known increase in kidney stone risk. If, because you can't get enough calcium in the diet and you do take calcium supplements, I agree with D.B. that 500 mg is the most you should take at one time. I also agree that magnesium is necessary, but most people get adequate magnesium from the diet and do not require supplementation.

Vitamin D is necessary for calcium metabolism, so a vitamin D supplement is necessary for many people with osteoporosis, especially those living north of Atlanta or Los Angeles. It is hard, but not impossible, to get adequate vitamin D through diet.

TO READERS: The booklet on constipation provides useful information on the causes and cures of this common malady. Readers can obtain a copy by writing: Dr. Roach -- No. 504, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2014/12/30/prescription-frustration-real/feed/0Colonoscopy is best screening test we have for colon cancerhttp://health.heraldtribune.com/2014/12/29/colonoscopy-best-screening-test-colon-cancer/
http://health.heraldtribune.com/2014/12/29/colonoscopy-best-screening-test-colon-cancer/#commentsMon, 29 Dec 2014 10:00:50 +0000http://health.wp.htcreative.com/?p=23389Read more »]]>DEAR DR. ROACH:My husband, who is 73 and in good health otherwise, had a colonoscopy in the summer of 2012 and was told that because no polyps or any problems were found, he did not need another test for 10 years. This October, he was diagnosed with stage 4 colon cancer, which has spread to the abdomen and omentum. He also had seven polyps removed during his latest examination.

My question is, How likely is it that such a virulent cancer could grow in such a short time? I would be resigned to the diagnosis if I didn't feel that something was missed in the initial exam. Also, I had a colonoscopy done by the same doctor this summer and also was told that I need not come back for 10 years. Should I be concerned? -- H.B.

ANSWER: I am very sorry to hear about your husband. What happened is very unusual. All guidelines agree that in a person with a normal colonoscopy, a repeat in 10 years is recommended. A repeat in five years would have been recommended if a low-risk polyp had been found, earlier with high-risk or multiple polyps. I haven't personally seen a case like your husband's, where an advanced cancer presents less than 10 years after a normal colonoscopy. This should happen in fewer than one in a thousand people.

There are several reasons why it can happen. The most important is that even a properly done colonoscopy misses polyps. Very small polyps (less than 5 mm) can be missed 26 percent of the time, but large polyps (greater than 10 mm) are missed only 2 percent of the time. Although the colonoscopy is the best screening test we have for colon cancer, it isn't perfect. It's also possible that he just had a very fast-growing cancer.

While I understand your concern about getting yourself an earlier repeat colonoscopy, your risk is very small, and if you trust the doctor who did the colonoscopy, you should get your repeat in 10 years.

DEAR DR. ROACH: I recently was diagnosed with a 40 percent to 50 percent blockage in my left carotid artery. I am an 85-year-old woman and not in good health. I have A. fib, a pacemaker, high blood pressure and a very weak heart. I go to a cardiologist, and he always talks about surgery. I don't think I could go through another surgery, much less test after test. I feel I should just let it alone, but would love to have your input. -- L.H.

ANSWER: The two carotid arteries supply your brain with blood. Blockages in these arteries are a major cause of stroke and TIA (transient ischemic attack, very similar to a stroke but lasting less than 24 hours). There has been debate about the proper treatment for blockages, and current recommendations are based on sex, degree of blockage and whether there are any symptoms. Men are at higher risk, and surgery has been shown to benefit men with no symptoms and blockages of 60 percent to 99 percent. Very few authorities would recommend surgery to women unless they had a blockage above 60 percent to 70 percent, were generally healthy and where the risk of stroke or death for the surgery was less than 3 percent. Because your blockage is only 40 percent to 50 percent and you have some other medical issues, I generally would not recommend surgery for someone in your situation.

Medical management should include aspirin or other antiplatelet medication, a statin drug and careful control of blood pressure. I would add that a healthy diet certainly will help, and quitting smoking and control of diabetes is absolutely necessary for smokers and diabetics, respectively.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2014/12/29/colonoscopy-best-screening-test-colon-cancer/feed/0Bleeding after menopause must be investigatedhttp://health.heraldtribune.com/2014/12/25/bleeding-menopause-must-investigated/
http://health.heraldtribune.com/2014/12/25/bleeding-menopause-must-investigated/#commentsThu, 25 Dec 2014 10:00:49 +0000http://health.wp.htcreative.com/?p=23313Read more »]]>DEAR DR. ROACH: I am a post-menopausal woman (12 years since my last cycle). Last month, I had a light period that lasted over a week. I have seen my OB/GYN, who sent me for a pelvic ultrasound and a transvaginal ultrasound. The only thing it showed was a thickening of the lining. I then had a biopsy, and the results came back showing normal cells. He seems stumped, and said that if it happens again, he'd suggest a D and C. But, as he acknowledged, a 66-year-old woman isn't supposed to be having periods. Obviously, he and I both know something isn't right but just don't know what it might be. Any thoughts? -- D.H.

ANSWER: Any bleeding after menopause needs to be evaluated, since it can represent uterine cancer about 10 percent of the time. Fortunately, that is very unlikely with a normal biopsy. Since you did have a thickened endometrium, it is possible that you have endometrial hyperplasia, though this should have shown up on the biopsy. An ultrasound should have picked up a polyp.

If it does happen again, you should certainly have further evaluation. Even though a negative biopsy is very good evidence that there isn't a cancer, no test is perfect. About 20 percent of women with persistent bleeding after a normal biopsy had cancer or a precancerous lesion. This occasionally happens when the uterine cancer is in one focal place, rather than present throughout the lining of the uterus.

DEAR DR. ROACH:My father read your recent column pertaining to kidney stones. He recently passed a kidney stone and was wondering if there is a lab that he could send his stone to directly to be analyzed? Unfortunately, he prefers not to visit an internist or urologist. -- L.P.

ANSWER: It depends on the state, but most laboratories require a professional's order to perform testing. I have mixed feelings about this; however, I generally agree, since a physician or other provider should provide individualized recommendations on the appropriate changes in diet, medication and fluid intake, based on the stone type, medications taken, diseases or conditions present and other factors. There are services available on the Internet that will perform laboratory testing without an order (by having a medical director in a given state order the lab), but I don't recommend it for the reasons above.

DR. ROACH WRITES: Back in early November, I asked readers for suggestions on swallowing pills, and I got many helpful answers, some of which can be found on my Facebook page: facebook.com/keithroachmd. I particularly liked this pharmacist's advice, since it combines physics and common sense:

"Because capsules FLOAT and tablets SINK, two ways are helpful. For capsules this works for me: place the capsule on your tongue, then take a big swallow of water through a straw, keeping your chin neutral. For tablets, put water in your mouth first, then tilt your head back and drop the tablet into your mouth and swallow."

Using a straw was the most frequent advice I heard. Thicker liquids were the key for other readers, while one reminded me that an inexpensive pill crusher can turn a pill to powder, which can then be mixed into yogurt or applesauce. However, always check with your pharmacist, since some pills, such as long-acting formulations, should not be crushed, and a few should not be mixed with foods. Another person found that swallowing some ice chips for a few minutes prevented the gag reflex that kept her from swallowing medicines.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

]]>http://health.heraldtribune.com/2014/12/25/bleeding-menopause-must-investigated/feed/0How to help a smoker break the addictionhttp://health.heraldtribune.com/2014/12/24/help-smoker-break-addiction/
http://health.heraldtribune.com/2014/12/24/help-smoker-break-addiction/#commentsWed, 24 Dec 2014 10:00:44 +0000http://health.wp.htcreative.com/?p=23311Read more »]]>DEAR DR. ROACH: I need your help to get my husband to stop smoking.

My husband and I have been together for 27 years. He has smoked cigarettes daily for at least 30-35 years. Recently, he had an attack where he couldn't breathe, and we took him to the clinic, where they did a breathing test. My 15-year-old son and I watched as my husband agonized to get through the test. They gave him an albuterol machine, prescribed him Advair and sent him on his way. His father also smoked for many years, and now is on oxygen for COPD -- he is miserable every day. My husband quit smoking about two years ago using Chantix, but he started smoking again shortly after that. I do not want to watch him suffer like his father. I don't understand how he sees what his father is going through and still continues down that road. I know it is not too late for him to stop, even though I am pretty sure he has already done some serious damage to his body.

Please let me know what I can do to get my husband to quit for good.

ANSWER: Quitting smoking is perhaps the most difficult recommendation to follow. There are some definite red flags in your husband's case as you have described it, but some reason to hope as well.

The fact that your husband can see the effects of smoking on his father but has not successfully quit is worrisome. On the other hand, quitting now will greatly slow down damage to his lungs. Similarly, although he restarted quickly after quitting, he was able to quit. He needs to know that most people who quit successfully have tried several times to quit in the past and went back. It's worth trying again, and he knows that he is able to quit.

Varenicline (Chantix), bupropion (Zyban and Wellbutrin) and nicotine replacement therapies definitely are helpful for most people in quitting. I am sure his doctor will be happy to partner with you, his family, in helping him quit.

The American Lung Association, Centers for Disease Control and Prevention, Health Canada and the American Heart Association all have helpful information for people trying to quit as well.

DEAR DR. ROACH:At age 45, I was diagnosed with bipolar II disorder. I am now 60 and have diligently taken medication, and I have never experienced the manic/depression swings associated with bipolar disease. I rarely hear anything about bipolar II. Can you tell me something about it? -- D.T.

ANSWER: Bipolar disorder is a complex spectrum of diseases that have in common drastic changes in mood and behavior. Depression is the most common initial mood disorder in bipolar disorder. Bipolar I disorder is diagnosed when there are manic episodes. A manic episode is defined medically as an abnormal, persistently elevated mood with increased activity or energy, lasting at least a week. Feelings of increased self-esteem, decreased need for sleep, being unusually talkative, having racing ideas and distractibility are common. Spending sprees, sexual indiscretions and foolish investments sometimes happen during these episodes.

In bipolar II, true manic episodes are not present. Depression always is, as is at least one episode of hypomania, which is similar to manic episodes but less severe or long-lasting. Bipolar II is probably underdiagnosed, partly because hypomania can be hard to recognize. It is important to make the diagnosis, since treatment is different, and it is worth reconsidering the diagnosis if treatment is ineffective.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.